Arthritis drugs could help save Covid-19 patients: Study

Medics attend to a Covid-19 patient in an isolation ward at the Kenyatta National Hospital's Infectious Disease Unit in Mbagathi, Nairobi, on April 17, 2020. 

Photo credit: Jeff Angote | Nation Media Group

Two additional drugs have been found to improve the health outcomes of Covid-19 patients.

The two are the latest medicines repurposed to manage Covid-19 after dexamethasone, a steroid.

One in every 12 intensive care patients with severe Covid-19 was successfully treated with these drugs, said Anthony Gordon, an Imperial College London professor of anaesthesia and critical care who co-led the study released as a preprint in the medical journal Medrxiv.

So far, dexamethasone and Gilead’s antiviral drug remdesivir have been approved for treating patients with severe symptoms.

Results from clinical trials of the two drugs called tocilizumab and sarilumab, announced last week by scientists in the United Kingdom, are currently used to reduce inflammation in patients with arthritis.

Immunosuppressive drugs

The immunosuppressive drugs – tocilizumab, also known as Actemra, and sarilumab, also called Kevzara – given as intravenous infusions, are developed by Swiss and French pharmaceuticals Roche and Sanofi, respectively.

Hyper-inflammation is a leading cause of death among severely ill Covid-19 patients – the immune system goes into overdrive and destroys the organs.

In the Remap-cap trial, results from about 800 patients confirmed the drug potentially cut the relative risk of death by 24 percent.

Reduced time

In addition to saving lives, the treatments also sped up patients' recovery and reduced the time that critically ill patients need to spend in intensive care by about a week.

The new drugs reduced the death rate by a quarter, to 27 per cent, when given to patients within 24 hours of them getting admitted in intensive care.

Until now, results for Actemra and Kevzara in treatment trials in patients with Covid-19 have been mixed. In September, Sanofi said that Kevzara, which it produces with partner Regeneron, failed to meet the main goals of an American study testing it in critically ill Covid-19 patients.

In November, Roche said research showed Actemra helped the sickest patients, but it was unclear if it kept people alive or shortened how long they needed intensive care support such as mechanical ventilation, or both.

In Kenya, Roche, partnering with the Aga Khan University Hospital in July, launched an experimental study to determine whether Actemra could be used as a potential treatment for Covid-19 patients.

Compared to dexamethasone, which costs around Sh744 (£5), the two drugs are not cheap, costing around Sh111,692 to Sh148,923 (£750 to £1,000) per patient.

Receptor antagonists

Actemra and Kevzara fall in the category of drugs known as IL-6 receptor antagonists, which are made of antibodies that block the effect of interleukin-6 (IL-6), a protein that stokes the immune response and has been prominent in Covid-19 patients.

The Remap-Cap (the randomised embedded multifactorial adaptive platform for community-acquired pneumonia) study involves more than 3,900 Covid-19 patients in 15 countries around the world. 

Randomised adult Covid-19 patients received standard care, a drip of either of the two drugs, within 24 hours of being put on organ support in intensive care. The researchers then monitored the patients’ progress for at least 21 days.

Mortality rate

While hospital mortality stood at 35.8 percent (142/397) for patients given standard care, it was 28.0 percent (98/350) for tocilizumab and 22.2 percent (10/45) for sarilumab.

Combining the results for the two drugs gave a hospital mortality of 27.3 percent (108/395) – an 8.5 percentage point drop in absolute risk of death, or a 24 percent relative reduction – compared with the group who had standard care.

About 80 percent of the patients in the Remap-Cap trial were also given dexamethasone or another steroid, offering additional benefit to Actemra and Kevzara.

“Treat 12 patients and you save one life,” said Prof Gordon, the UK’s chief investigator on the trial behind the findings. “[That’s] a big effect.”

Quicker recovery

The team also found those given either of the two medicines recovered more quickly, and were able to be discharged from intensive care units around seven to 10 days earlier than those who did not get these drugs.

Dr Lennie Derde, intensive care consultant and European coordinating investigator of the Remap-Cap trial, said the international nature of the trial was important, given the worldwide impact of the pandemic.

“The results are applicable not just in the UK but across the globe,” she said.

According to the BBC, the UK government had issued an export restriction on the two drugs, banning companies from buying medicines meant for UK patients and selling them on for a higher price in another country.

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